Shocking precedent: court approved euthanasia
The next storm? • initial publication: Magistrates Court in Tel Aviv allowed to reduce respiration of ALS patient in a manner that would certainly bring about his death • The decision was made after receiving the opinion of the Attorney General, who noted that this is not a terminal patient and "we wish we would not be required to make such difficult decisions" • Inside: full story
- Eli Schlesinger
- י"ח כסלו התשע"ה
Illustration photo. Flash 90
Precedent? The court - after receiving a legal opinion from the Attorney General - partially granted the request of a terminally ill muscular dystrophy patient, to be disconnected from the respirator to which he is connected. According to the judgment, under the conditions presented, a gradual reduction of the respirator's rate will be performed, so that the machine will not be disconnected but will not provide enough oxygen to the patient and that will lead to his death.
Two weeks ago, judge Rachamim Cohen from Tel Aviv Magistrates Court, after receiving the opinion of the attorney general, Yehuda Weinstein, confirmed a ruling, confirming agreements between the parties to agree to the request of a patient with ALS (fatal degenerative muscle disease) who is dying, to disconnect him from appliances and thereby cause his death.
The Legal Advisor recently submitted its position in the process clarified in the District Court in Tel Aviv, in the case of a patient with ALS, who asked that he be allowed to be disconnected from the respirator. The patient, who suffered for years from a terminal muscular dystrophy disease known as ALS, expressed his explicit request to disconnect from the ventilator to which it he connected. The request was supported by affidavit and using medical opinions.
The Attorney General pointed to the difficulty in formulating a position in such cases, involving complex questions of law, morality and religion. In our case, the applicant does not meet the definition of a "Dying Patient," as it was defined in the law, as his life expectancy exceeds six months, as long as he is connected to a respirator. The Attorney General stated that even assuming the Patients' Rights Act does not apply, one should follow the inspiration of the Dying Patient Act.
In his position, the Attorney General noted that the Dying Patient Act seeks to create a careful balance between the sanctity of life and the value of the autonomy of the will of man and the importance of quality of life. As a result, the law creates a distinction between an active action, which leads to the death of a person, and passive action, default (or refraining from medical treatment), a default that could lead to the disease increasing in a person and overcoming him. The law states that the active action is prohibited, while giving medical care could not be prohibited.
Accordingly, the Attorney General determined that there is no legal impediment to the special circumstances of the case, that the patient will continue to be constantly connected to a ventilator, but at the same time a gradual reduction in the rate of the respirator will be performed and oxygen concentration up to 21% (which is the concentration of oxygen in normal air). In this way there will be no disconnection from a respirator, while medical care will not be imposed on the applicant, as he does not wish that.
The Attorney General chose to conclude his position as follows: "The court's work in such cases is as hard as splitting the Red Sea. Who is wise and knows how to act and how best to go".
"We wanted to find a proper balance, in the track set by the legislature, in the most difficult question: "Who shall live and who shall die... who will be blissful and who shall suffer". We wish we did not have to be required to make difficult choices such as these."
In view of the opinion, Judge Rachamim Cohen from Tel Aviv Magistrate's Court ruled: "A declaratory judgment is hereby given pursuant to which the doctor will perform the procedure may take the following actions:
A. The doctor who performs the procedure must make sure beyond all reasonable doubt, that the applicant is convinced only if he answers in the affirmative and will wish so, it will be possible to accede to his wishes.
B. To perform a gradual reduction in the rate of respirator, up to the minimum, while providing palliative sedation.
C. Avoid monitoring of blood oxygen saturation, blood gases and electrolytes.
D. The process will be documented appropriately, in accordance with the medical procedures".
Two weeks ago, judge Rachamim Cohen from Tel Aviv Magistrates Court, after receiving the opinion of the attorney general, Yehuda Weinstein, confirmed a ruling, confirming agreements between the parties to agree to the request of a patient with ALS (fatal degenerative muscle disease) who is dying, to disconnect him from appliances and thereby cause his death.
The Legal Advisor recently submitted its position in the process clarified in the District Court in Tel Aviv, in the case of a patient with ALS, who asked that he be allowed to be disconnected from the respirator. The patient, who suffered for years from a terminal muscular dystrophy disease known as ALS, expressed his explicit request to disconnect from the ventilator to which it he connected. The request was supported by affidavit and using medical opinions.
The Attorney General pointed to the difficulty in formulating a position in such cases, involving complex questions of law, morality and religion. In our case, the applicant does not meet the definition of a "Dying Patient," as it was defined in the law, as his life expectancy exceeds six months, as long as he is connected to a respirator. The Attorney General stated that even assuming the Patients' Rights Act does not apply, one should follow the inspiration of the Dying Patient Act.
In his position, the Attorney General noted that the Dying Patient Act seeks to create a careful balance between the sanctity of life and the value of the autonomy of the will of man and the importance of quality of life. As a result, the law creates a distinction between an active action, which leads to the death of a person, and passive action, default (or refraining from medical treatment), a default that could lead to the disease increasing in a person and overcoming him. The law states that the active action is prohibited, while giving medical care could not be prohibited.
Accordingly, the Attorney General determined that there is no legal impediment to the special circumstances of the case, that the patient will continue to be constantly connected to a ventilator, but at the same time a gradual reduction in the rate of the respirator will be performed and oxygen concentration up to 21% (which is the concentration of oxygen in normal air). In this way there will be no disconnection from a respirator, while medical care will not be imposed on the applicant, as he does not wish that.
The Attorney General chose to conclude his position as follows: "The court's work in such cases is as hard as splitting the Red Sea. Who is wise and knows how to act and how best to go".
"We wanted to find a proper balance, in the track set by the legislature, in the most difficult question: "Who shall live and who shall die... who will be blissful and who shall suffer". We wish we did not have to be required to make difficult choices such as these."
In view of the opinion, Judge Rachamim Cohen from Tel Aviv Magistrate's Court ruled: "A declaratory judgment is hereby given pursuant to which the doctor will perform the procedure may take the following actions:
A. The doctor who performs the procedure must make sure beyond all reasonable doubt, that the applicant is convinced only if he answers in the affirmative and will wish so, it will be possible to accede to his wishes.
B. To perform a gradual reduction in the rate of respirator, up to the minimum, while providing palliative sedation.
C. Avoid monitoring of blood oxygen saturation, blood gases and electrolytes.
D. The process will be documented appropriately, in accordance with the medical procedures".
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